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General NPI Number Information
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NPI Number | 1275916934
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Entity Type | Organization
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Legal Business Name | BLUE VALLEY SURGICAL ASSOCIATES, LLC
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Dates
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Enumeration Date | 06/30/2015
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Last Update Date | 06/30/2015
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Provider Practice Location Address
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Address Line | 2341 HIGHWAY K SUITE 214
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City | O FALLON
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State | MO
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Zip | 63368-8604
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Country | US
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Telephone | 636-542-6020
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Fax |
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Provider Business Mailing Address
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Address Line | 12920 METCALF AVE STE 250
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City | OVERLAND PARK
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State | KS
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Zip | 66213-2699
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Country | US
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Telephone | 913-428-4723
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Fax |
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Authorized Official
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Title or Position | OWNWE-CEO
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Name | DOUGLAS PALZER
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Credential |
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Telephone | 913-428-4723
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 2015020560
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License Number State | MO
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